Youth Peer Education in Reproductive Health and HIV/AIDS: Progress, Process, and Programming for the Future

The conclusion of the January 2006 U.S. Agency for International Development (USAID) and Family Health International (FHI)/YouthNet sponsored consultation was that youth peer education programmes, now receiving large investments as a development communication approach, must be conducted with as much attention to design, diligent implementation, evaluation, and commitment to results as any other reproductive health or HIV/AIDS intervention. This 28-page report on the consultation summarises the latest thinking on youth peer education with evidence of the degree of impact, examples of programmes that are scaling up activities, and suggestions for the future. The consultation served to:

• Provide an update on youth peer education experience
• Better understand where and how youth peer education has been used
• Examine the successes and failures of youth peer education objectively
• Explore specific issues related to successful youth peer education efforts

According to this report, as a strategy, peer education programmes train representative adolescents by providing information on adolescent reproductive health (RH) or HIV/AIDS. It is a tool typically used in conjunction with other means
of communication and information dissemination, such as media campaigns, advocacy by celebrity spokespersons, and youth-friendly services and varies in its setting, frequency of contact, and follow-up. As stated here, when done well, peer education requires intensive planning,
coordination, supervision, and resources, with associated programme costs inherent in each
element of a peer education programme – training, support, supervision, supplies, and allowances. Since these programmes frequently generate a need for health services, they need to be linked or integrated with services to provide access to condoms and other contraceptives,
medical care, voluntary counselilng and
testing (VCT), and management of sexually
transmitted infections (STIs) and may also need links to support to orphans or home
and hospice care. They can connect to media
or social marketing campaigns and advocacy campaigns. The report lists theoretical approaches, drawing on cognitive theories, theories of collective action and group empowerment from fields of health psychology, health education, and public health.

The report identified several important challenges. These challenges are grouped into six major programme issues: standardised resources; training approaches and needs; retention; monitoring and evaluation; context and social norms; and gender concerns and marginalised population. Each is addressed in detail in the report, including the following topics:

• There is a need for standards and clarity of operational frameworks; research on cost effectiveness and productivity of programme design; and effective monitoring and evaluation instruments.
• Training and adult/community support are critical.
• Training should model
  and replicate the instructional methods to
  be used, and former educators as trainers may be an enhancement.
• Core training elements include: technical (gender and sexuality) content; legal and ethical concerns; communication, group, and leadership skills; counselling skills; response to peer pressure; recordkeeping, self-assessment, and evaluation; and interactive practice and skill modeling.
• Retention can be enhanced by close supervision, career development, creative compensation, and full participation in programme implementation.
• Communities and educational leaders need the following to support peer educators actively: knowledge; critical thinking; identity and solidarity, empowerment, motivation, and confidence; supportive social networks; and access to services and resources.
• Issues of gender and marginalised populations that surface require: teaching gender sensitivity in the context of
  field settings and facilitated open discussion among peer educators
  about gender and gender roles to clarify their
  association with sexual and reproductive
  health.
• Scaling up and its complexity is analysed throgh the Y-PEER programme of the United Nations Population Fund (UNFPA), National Organization of Peer Educators
  (NOPE), an NGO headquartered in Nairobi,
  Kenya,nd plans for the
  establishment of a South Africa Peer Education
  Support Institute.

The section on future directions calls for an operational definition of peer education, quality standards, clarity of contextual environment and social norms in which programmes are established; and more research.

The recommendations section reiterates the need for rigorous planning and implementation of youth peer education efforts as health behaviour change interventions including the need for closer attention to standards. Characteristics
known to contribute to effective curriculum-based sexuality and HIV education for youth might provide guidance.